Screening all women about domestic-violence experiences when they visit a health clinic doesn't prevent future abuse or result in improved lives, says a study released Tuesday.
The study's findings, reported in the Journal of the American Medical Association (JAMA), echo an earlier, large-scale study that also found no benefit to the strategy of "universal screening" for domestic-violence intervention.
The new findings suggest that it's time to move beyond the idea of asking all patients about domestic violence, and focus instead on responding to those "who show signs and symptoms of abuse," Canadian academic C. Nadine Wathen, who was not involved in the study, wrote in an accompanying editorial in the Aug. 14 issue of JAMA.
"[U]niversal screening does not improve women's health or life quality or reduce re-exposure to partner violence," added Ms. Wathen, a faculty member at the University of Western Ontario and co-author of a separate large-scale study that concluded in 2009 that "there is insufficient evidence to support" the universal-screening recommendation. "It's time to enact an approach in which individual women are assessed according to their presenting histories, which include symptoms and risks."
Many medical organizations and the Institute of Medicine favor the concept of screening all patients, especially women, about domestic violence at many or all of their routine health-care appointments.
The rationale is that victims are often reluctant to talk about their "hidden" abuse, but if health-care providers ask about it, victims who are afraid or ashamed may speak up. "Universal screening is a vital means to identify those women who suffer in abusive relationships with intimate partners," explained a 2001 article in the Journal of Professional Nursing.
The new study in JAMA, led by Dr. Joanne Klevens, an epidemiologist at the violence prevention division at the Centers for Disease Control and Prevention (CDC), tested this premise with more than 2,000 women who visited health-care facilities in Chicago between May 2009 and April 2010.
The female patients were randomly sorted into three groups. Everyone in the first group was asked to take a computer-assisted screening that asked them three questions — had they been "hit, kicked, punched or otherwise hurt by someone within the past year," did they "feel safe" in their current relationship, and was a previous partner "making you feel unsafe now."
Any woman who answered "yes" to at least one question was shown a video about how to get help for domestic violence and given materials on social services, including a list of domestic-violence shelters and services.
(Women who answered "no" to all questions received materials on general social services only.)
Women in the second group were given information about domestic-violence and other social services, but were not screened.
The third group of women received general information about social services, but weren't screened or given domestic-violence resources.
A year later, 2,364 women were interviewed.
"What we found was that there were no significant differences between the three groups of women" on any measure, including quality-of-life questions, hospitalizations, emergency room visits or missed days of work, said Dr. Klevens.
Importantly, the follow-up interview found that 346 women had experienced domestic abuse in the year before joining the study. Most of these women — 235 or 68 percent — said they had experienced more abuse in the past year, but again, there was no difference between the groups — women in the intervention group were just as likely to experience abuse again as women in the other two groups.
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